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Unique Program For Children With Cancer

A diagnosis of cancer generates a host of emotions and the painful question: will I survive this disease? Cancer treatments, long and sometimes painful, can propel a patient, family and friends into a whirlwind that affects all domains: physical, social, emotional and professional. In such a time of torment and upheaval, many patients with cancer turn to complementary therapists for ease and respite from the long journey through illness and treatment.

Leucan is a charitable (non-profit) organization based in Quebec whose mission is to enhance the well-being and healing of children with cancer and ensure support for their families. Leucan offers a number of services to its members, including financial assistance, emotional support, social and recreational activities, and notably, massage therapy.

“Leucan’s team of massage therapists is specially trained to support child and adolescent cancer patients throughout the length of their illness providing individualized massage therapy care. This service is also available for family members. This innovative program was developed by Mrs Lyse Lussier, a massage therapist by training, and now director of programs, services and research at Leucan.

During the 1980s, Lussier undertook her massage therapy training in the United States where she studied Swedish massage, therapeutic touch, polarity and Trager. Through her teachers, Lussier was influenced by Dr. Elizabeth Kübler-Ross, and her work with patients at the end of life.

On her return to Montreal, Lussier wanted to continue using massage therapy as a support for those with serious illnesses. She learned of the plans of a medical oncologist and certain cancer nurses at Sainte-Justine University Hospital Center, a university teaching hospital, to start a pilot project through Leucan using massage therapy to complement  medical treatment for children with cancer. Lussier was hired by Leucan and thus began her career providing massage therapy to hospitalized children suffering from leukemia and other forms of cancer. 

Popular with children and their families, the hospital massage therapy program rapidly grew to 21 hours a week. The pilot project became an official program of Leucan, offering children and adolescents an opportunity to obtain comfort, a sense of well-being, and moments of relaxation. 

During this formative period at Leucan, Lussier was also invited to join her colleagues from the social and recreational section in organizing a summer camp. After the first summer, Lussier invited other massage therapists to join the team of volunteers she supervised in offering massage to sick children and members of their families on site at the camp.

For 18 years now, Leucan’s teams of specially trained massage therapists offer children with cancer the opportunity to get more in touch with their bodies, to experience a sensation of calm and, often, a feeling of inner replenishment.

As first priority, children in hospital are offered the massage therapy support program. Four Paediatric Oncology Centres in the Province of Quebec participate in this program: Sainte-Justine University Hospital Center, the Centre Mère-Enfant du CHUQ in Quebec City, the CHUS in Sherbrooke and the Montreal Children’s Hospital of the McGill University Health Centre.

Once children leave the hospital, Leucan also offers supportive massage therapy in the home for children and for other family members. This service is co-ordinated through nine regional offices of Leucan around the province. Massage therapy continues to be offered at summer camp and at special events throughout the year. The hospital program is wholly financed by Leucan for the benefit of its members while families may pay part of the cost for massage therapy services offered in the home.

Massage therapy provided at home not only brings comfort and repose to the child but has the added advantage of maintaining supportive contact with the family throughout the trajectory of the illness.

The aim is to offer a massage session once a week per household. The massage therapist stays alert to the needs of the family and plays a key supportive role linking the family to local services or other programs offered by Leucan.

Since February 2000 Leucan has been tracking the activities of its massage therapy team. In the financial year 2004-2005, 50 massage therapists provided 2,000 massage sessions in the four Paediatric Oncology Centres in the Province of Quebec, and 2,112 sessions in the homes of Leucan members. Leucan is also interested
in monitoring the quality of these interventions and eventually in developing a research project around them.

As part of a quality assurance assessment to ascertain the breadth of benefits and the nature of limitations of the service, Andréa Maria Laizner, a PhD nurse researcher at the McGill University Health Centre and Sainte-Justine University Hospital Center assisted with the conduct and analysis of three focus groups with 18 Leucan members who had participated in the massage therapy program [1,2]. Half the focus group members were parents, and half were children or adolescents who had received massage therapy in the past. Parents and children were not from the same families.

Participants talked about their memories of the massage therapy experience. Foremost among their memories was the relationship with the therapist and the strength of that relationship, which was perceived as a source of support. 

Children noted different points: some found that massage therapy helped promote sleep or relaxation; others that it reduced muscle tension, or provided a distraction from the cancer experience. (See 13 year-old’s quotes, below, taken from the Leucan Brochure.) Some children talked about receiving massage at home, or in the hospital.

One adolescent recalled massage therapy at camp and the experience of children learning how to give massage to each other.

Some parents reported that they experienced a release of their own suffering when they saw a change in the affect of their child in response to the arrival of the therapist. Other parents used the massage sessions as respite from care. The main limitation noted by the researcher was that parents visiting their children in hospital refused offers of massage therapy for themselves, preferring that it should be offered to their sick children.

Once home, however, parents were more likely to be willing to receive massage therapy. In general, the effects following massage therapy noted in these focus groups are similar to those being reported in the oncology literature [3-6].

As the massage therapy program at Leucan grew, and more therapists became interested in this work, so the massage therapy training also developed. The course created by Lussier is now taught through Guijek, the Quebec Institute for Integral Health. Guijek continues to partner with Leucan and other volunteer organizations dedicated to helping people with cancer.

The 160-hour program is open to massage therapists who have completed their basic training and who are interested in working with this special population.
Therapists taking the course have the choice of a variety of sites for practical training and may choose to work with children, or adults with cancer, in hospital or in palliative care facilities. The theoretical component of the course is completed before practical training begins.

Students first learn about cancer and its various manifestations, treatments, side effects, and the illness trajectory, emotional and physical concerns and coping styles of cancer patients and their families. Students have frequent opportunities to practice clinical decision-making skills, to participate in reflective exercises, and to gain an understanding of how complementary therapists work with the medical team and hospitalized patients with cancer. 

At one time massage therapists were taught that cancer was a general contraindication for massage therapy. There is no compelling evidence for the belief that massage therapy can spread cancer through increased circulation [7].

As more becomes known about tumour biology and the chemical and molecular processes involved in cancer development and metastasis, massage therapy teachers and clinicians are concluding that contraindications for massage therapy are often local or specific. For example, Curties and MacDonald both recommend avoiding direct pressure over a known tumour site, over areas of known bone metastasis, in addition to the usual precautions regarding areas of bruising and fragility [8, 9].

Therapists treating patients with cancer do have much to learn, however, not only about the processes of the disease itself, but about the effects of surgery, radiation and chemotherapy which take their toll on the human body and psyche.

Clinical decision-making requires knowledge of the current immune status of the patient, the level of various markers in the blood, and which areas of the body are undergoing or have been recently radiated.

There will be occasions when massage therapy is not indicated at all, and other times when a gentle, slow or static touch to the feet or hands may offer comfort to a patient for whom a more general massage may not be possible.

The focus of medical treatment is on curing cancer. Massage therapy is not curative but can play a supportive role in contributing to quality of life by tempering physical and associated psychological discomfort.

Patients diagnosed with cancer are often overwhelmed, depressed, or find it difficult to cope [10].

Meta-analysis of published massage therapy research found that the largest effects of massage therapy were in reducing anxiety and depression [11]. It may be significant that the participants in the focus groups (described earlier) talked about the importance of the relationship with/ presence of massage therapist.
Indisputably, there is much to learn and there are many myths to investigate as we establish our role in caring for people with cancer. 

The supportive massage therapy program for patients with cancer helps students overcome their fears and in so doing, changes their perceptions. This teaching demonstrates that compassionate, nurturing touch can be safely offered to patients with cancer. Judicious choice is necessary regarding which massage therapy techniques are appropriate, and how they may be adapted in specific circumstances, but there is no doubt that there is a place for massage therapy in cancer care.

References
1.     Laizner, A., and Lussier, L., “Massage provides comfort to children with cancer: the child’s perspective”. Journal of Complementary and Integrative Medicine, 2005. 2 (1): p. 34.
2.     Laizner, A., and  Lussier, L,. “Massage program relieves suffering for parents while provides comfort for children.” Journal of Complementary and Integrative Medicine, 2005. 2(1): p. 35.
3.     Goodfellow, L., “The effects of therapeutic back massage on psychophysiologic variables and immune function in spouses of patients with cancer.” Nursing Research, 2003. 52(5): pp. 318 – 328.
4.     BIllhult, A., & Dahlberg, K., “A meaningful relief from suffering.” Cancer Nursing, 2001. 24(3): p. 180 – 84.
5.     Corbin, L., “Safety and efficacy of massage therapy for patients with cancer.” Cancer Control, 2005. 12(3): pp. 158 – 164.
6.     Myers, C., and Bonamer-Rheingans, J.,  “Complementary  therapies and childhood cancer.” Cancer Control, 2005. 12(3): pp. 172 – 180.
7.     Manuel, F., et al., “Massage and compassionate touch for persons with cancer”, in Supportive Cancer Care, E. Rosenbaum and I. Rosenbaum, Editors. 2001, Sourcebooks: Naperville, Illinois.
8.     MacDonald, G., “Medicine Hands.” 1999: Findhorn Press.
9.     Curties, D., “Massage Therapy and Cancer.” 1999: Curties-Overzet.
10. Rosenbaum, E.H., and Rosenbaum, I., “Introduction,” in Supportive Cancer Care, E.H. Rosenbaum and I. Rosenbaum, Editors. 2001, Sourcebooks: Napierville Illinois.
11. Moyer, C.A., Rounds, J., Hannum,  J. W., “A meta-analysis of massage therapy research.” Psychological Bulletin, 2004. 130(1): pp. 3-18.